Cervical Cancer
What is Cervical Cancer?
Cervical cancer develops at the uterine cervix. App. 70% are squamous cell cancers, 25% are adenocarcinomas and 5% are rare histologies.
What is the main cause of cervical cancer?
About 99% of cervical cancers are caused by a human papilloma virus (HPV) infection.
What are the symptoms of cervical cancer? Can you feel a cervical tumor?
In early stages cervical cancer does not cause any symptoms. It therefore can only be detected by cervical cytology, colposcopy and biopsy. In more advanced stages the tumor leads to irregular bleeding, vaginal discharge, pelvic pain. In very advanced stages it can involve the bladder, rectum and can cause hydronephrosis.
Where does cervical cancer usually start?
Cervical cancer mainly starts at the transformation zone. This is the area where the squamous epithelium passes over into cervical mucosa. Adenocarcinomas frequently originate in the cervical canal.
Can you feel a cervical tumor?
You usually cannot feel a cervical cancer by self-palpation.
What’s the most common age for cervical cancer?
The age peak for cervical cancer is around 45 to 55 years. This age peak can be explained by the nature of a HPV infection. Once a HPV infection persists it takes about 5 to 10 years until cancer develops. HPV infections occur mainly in young sexually active women. After the age of 30 persistent HPV infections increase because of immune system aging. The latency of persistent HPV infection until the development of cancer leads to the mentioned age peak.
What risks or side effects are there to the treatments you suggest? Are there things we can do to reduce these side effects?
There are two therapeutic strategies to treat cervical cancer. Surgery and primary chemo-radiation. Surgery includes pelvic lymphadenectomy and radical hysterectomy (RHE). Lymphatic morbidity can be significantly reduced by detection and removal of sentinel lymph nodes (SLN). We remove SLNs by laparoscopy. If a SLN is positive RHE is abandoned and periaortic lymphadenectomy to tailor the extent of the radiation field is added. If SLNs are negative a nerve sparing RHE by laparotomy (Pfannenstiel) is performed. If fertility is desired, we can offer a radical trachelectomy in selected cases, a technique which preserves the uterine corpus and fertility. Long term side effects of surgery are rare. Problems to void the bladder can occur but usually disappear in a few weeks after surgery. The combination of surgery and radiotherapy has the highest toxicity and should be avoided.
Should we consider preventive surgeries if we have risk factors for cervical cancer?
Because nearly all cervical cancers are caused by a HPV infection preventive surgery is not reasonable. The most effective way to prevent cervical cancer is HPV vaccination. In fact, a high vaccination rate of girls and boys before sexual activity could possibly eradicate cervical cancer.
What are the most common surgical procedures? What about other therapies?
As already mentioned, SLN removal followed by RHE is the surgical technique of choice to treat early stage cervical cancer (stage I). In selected cases if fertility preservation is desired radical trachelectomy can be performed. In advanced stages (Stage II and more) concomitant Chemo- and radiotherapy (external beam plus Image guided brachytherapy) is the treatment of choice.
If cervical cancer is caught early and treated, how many of these women are likely to be alive 5 years later?
In early stage cervical cancer (tumor confined to the cervix) with negative lymphnodes the 5-year overall survival is more than 90%.